Taking stock of a year of promise that went wrong

Reflecting on her first year as editor, Sofia Lind looks at how what initially seemed like a good trajectory for general practice slowly soured as 2025 went on

As we head towards Christmas, this feels like a good moment to take stock. Both of my first year as editor of Pulse, but also of the year in general practice as we have reported on it.

2025 began with a lot of promise.

The year opened with the first negotiated GP contract in four years. At Pulse LIVE London, Stephen Kinnock, the primary care minister, spoke about his relief that the relationship with GPs had been mended and about his commitment to the partnership model.

That felt significant. It suggested a Government that wanted to reset relations with general practice.

But that mood did not last.

The Leng review

The next major milestone for me as editor came at Pulse LIVE again, this time in Birmingham in June. Our keynote guest was Professor Gillian Leng, and I interviewed her on stage about her review into physician associates and how their introduction into the NHS has worked.

By this point, the debate around PAs had become deeply polarised, and at times toxic. GPs were raising legitimate concerns about patient safety, scope of practice and accountability. The Leng review did not set out a full scope of practice, but it did suggest a clear starting scope for newly qualified PAs. It also recommended that they be renamed physician assistants, to make it clearer to patients that these are not doctors.

The Government accepted the review in full. But many of its recommendations have still not been implemented.

You may have noticed that things have gone very quiet. If you ask UMAPS, the physician associates’ trade union, this is because of the legal action it has taken, which is still ongoing. If you ask NHS England, you get nothing at all. We have repeatedly asked for clarity and have repeatedly been refused answers.

GPs deserve clarity on this, and we are hoping to see meaningful movement on the Leng review in 2026. In the meantime, practices are voting with their feet, and PA numbers in general practice continue to fall.

Weight-loss drugs rollout

Summer also brought the rollout of Mounjaro into primary care. Again, this was something we covered closely as it unfolded. It came with insufficient preparation, and not all ICBs were ready. GPs were left fielding large numbers of patient queries that, in many cases, they were unable to resolve. This was no surprise as national media headlines went big on the fact GPs could prescribe the drug, but the truth was woefully different, creating a huge gap between expectation vs reality. What we are hoping for in 2026 is something very basic: services in place, and answers that GPs can actually give to patients.

The 10-year plan

Another pivotal moment came in July, with the publication of the Government’s long-awaited 10-year health plan.

General practice was repeatedly described as a key pillar of the NHS in the lead-up, but when we analysed the detail, it was hard to see what that actually meant. Two new GP contracts were mentioned, but the plan was vague on how they would work and how they would interact with the existing GMS contract.

Six months on, those questions remain unanswered and they have the potential to create a full-on existential crisis in general practice in England.

The breaking point

What started as a promising relationship between the Government and the BMA came to an abrupt end when the full details of the 1 October contract changes to online access were published. That was when it became clear that the safeguards the BMA had spoken about were not going to be in place.

From 1 October, practices were required to keep phones, doors and online consultation tools open throughout core hours. This fundamentally changed how practices operate and how GPs work – many GPs now spend entire shifts sifting through online requests to ensure nothing life-threatening is being missed.

In the weeks following the changes, the tone between the Government and the BMA deteriorated rapidly. Accusations of lying and name-calling from both sides ensued.

We were then first to report that the BMA would be removed from formal negotiations for the 2026/27 GP contract and treated instead as one stakeholder among many in a consultation process – a major departure from the usual way GP contracts are handled.

That is why we devoted this week’s Pulse in Focus podcast to the significance of the BMA being frozen out of contract negotiations, why it matters, and what it could mean going into 2026.

Time to change the tone

This is not the only way to tell the story of this year. But looking back at it from where I sit, one thing stands out clearly: what started off as seemingly a constructive situation for general practice over the course of the year turned into what can only be described as a cesspit.

What 2026 needs is no more talk of liars. No more GP ‘moaning minnies’ or ‘laggards’ accusations. Serious, grown-up discussions are needed. The Government cannot reshape general practice while freezing GPs and their representatives out of the room.

There is a lot at stake in 2026 and general practice deserves better than the lot it currently has.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn